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  • Welcome to the 2019 National Healthcare Safety Network, or NHSN quick learn series.

  • These are brief and informative presentations from the Centers for Disease Control and Prevention.

  • They serve as an educational resource for healthcare facilities working to prevent Healthcare

  • Associated Infections, or HAI's.

  • In this Quick Learn we discuss using the Targeted Assessment for Prevention Strategy, or TAP.

  • We'll review the TAP Strategy and how generating reports can assess and guide HAI prevention efforts.

  • By the end of the lesson you will be able to: Identify the three components of the TAP

  • strategy, Know the elements used to create a TAP Report, Define and calculate the Standardized

  • Infection Ratio or SIR or Define and calculate the Cumulative Attributable Difference or

  • (CAD), Learn how to calculate the CAD using an HAI Reduction Goal, and Learn how to create

  • a TAP Report in NHSN . Let's get started with defining the TAP strategy.

  • What is the TAP Strategy?

  • The Targeted Assessment for Prevention Strategy, or TAP, is a method developed by the Centers

  • for Disease Control and Prevention to apply NHSN data toward strategies to eliminate HAI's.

  • The TAP Strategy can help target healthcare facilities and specific units within facilities

  • with a disproportionate burden of HAI's so that gaps in infection prevention in the

  • targeted location can be addressed.

  • Several partners are involved in this strategy, including the Centers for Medicare & Medicaid

  • Services, or CMS, Quality Innovation Network-Quality Improvement Organizations, State Health Departments,

  • healthcare systems, and facilities.

  • TAP uses data for action, by helping facilities identify locations with excessive HAI's,

  • prioritizing prevention efforts, and evaluating performance toward reaching prevention goals.

  • Target, Assess, and Prevent are the 3 main objectives of TAP.

  • The “T” in the TAP strategy stands forTarget”.

  • Using TAP Report functions available in NHSN, can help facilities and unit locations with

  • a higher burden of infection.

  • Next is “A”, it stands forAssessuses the Facility Assessment Tools for the

  • TAP Strategy to assess gaps in a facility's infection prevention resources.

  • And lastly, the “P”, which stands forPrevent”, aims to prevent HAI's by

  • providing facilities with infection prevention strategies to address the identified gaps.

  • While all three steps are equally important, this Quick Learn will focus on the first step

  • of the TAP strategy, targeting facilities.

  • TAP reports have the ability to give facilities more insight into their data and help them

  • develop a strategy for HAI prevention.

  • TAP Reports bring together data elements from various places within NHSN, such as the Annual

  • Survey, Rate Tables, SIRs, and Event-level information for catheter-associated urinary

  • tract infections or CAUTIs, central line-associated bloodstream infections , or CLABSIs, C. difficile

  • infections CDIs and MRSA LabID.

  • Here, we can see the TAP Reports are available for each facility type.

  • Acute Care Hospitals can run CLABSI, CAUTI, CDI LabID, and MRSA LabID TAP Reports.

  • For Long Term Acute Care Hospitals, there are CLABSI, CAUTI, and CDI LabID TAP Reports.

  • Inpatient Rehab Facilities have CAUTI and CDI LabID reports.

  • Now, let's discuss an overview of the SIR and the CAD.

  • The Standardized Infection Ratio or SIR is a summary measure used to track HAIs at a

  • national, state, or local level over time.

  • The SIR adjusts for various facility and/or patientlevel factors that contribute

  • to HAI risk within each facility.

  • The Cumulative Attributable Difference or CAD is used to identify facilities and units

  • with a higher burden of HAIs.

  • The CAD allows specific gaps in infection prevention to be identified and addressed.

  • The SIR is a measure that compares the observed number of HAIs to the number of infections

  • that would be predicted based on national baseline data.

  • An SIR of 1 indicates that the number of observed infections reported to NHSN is equal to the

  • number of infections predicted, given the US baseline data to which HAI data are being compared.

  • While an SIR greater than 1 indicates that a group or facility has more observed infections

  • than predicted, an SIR less than 1 indicates that a group or facility has fewer observed

  • infections than predicted.

  • SIR accounts for differences in incidence and exposure across available factors known

  • to be associated with the given HAI or event.

  • The predicted number of infections in the SIR ratio is influenced by many factors including

  • incidence and exposure across the facility.

  • For example, the summarized HAI experience at a hospital with a large burn unit, a location

  • associated with higher HAI incidence, cannot be directly compared to a facility without

  • a burn unit unless this difference in exposure and incidence is taken into account.

  • As a result of differences in exposure and incidence, the predicted number of HAIs will

  • vary among hospitals or facilities.

  • Factors that are taken into account in the calculation of an SIR, sometimes calledrisk

  • factors,” help to promote comparisons that are more fair and valid.

  • Cumulative attributable difference, or CAD, is a measure that shows the difference between

  • the number of observed infections and predicted infections multiplied by an SIR goal in a defined period.

  • When we incorporate an SIR goal into our calculation for CAD, the value of CAD represents the number

  • of infections that a healthcare facility or organization needs to prevent to reach that

  • specific HAI reduction goal.

  • Therefore, depending on the choice of an SIR goal, the magnitude of CAD will vary.

  • A positive CAD means, more infections than what would be predicted with regard to an SIR goal.

  • A Negative CAD means fewer infections than what would be predicted.

  • It should also be noted that CAD is not a metric to compare performance of units or

  • facilities like SIR because CAD is not adjusted by risk exposure size, for example, catheter days.

  • The CAD was developed as a prioritization metric to target the facilities and units

  • with the highest burden of excess infections to help reach the targeted SIR goal.

  • Therefore, ranking the facilities and units by CAD value in descending order is the basic

  • concept of TAP report generation.

  • An important component of the CAD calculation is the HAI Reduction Goal.

  • The HAI Reduction Goal can be calculated using the HHS action plan goals for 2020 or a customized

  • SIR goal the HHS goal for 2020 can be found at the HHS website for National Targets and Metrics.

  • The link is displayed on this slide.

  • Here is an example of the influence of the SIR goal on the CAD calculation.

  • As the goal SIR becomes lower, the CAD, or the number of infections the facility would

  • need to prevent to reach the SIR goal, increases.

  • For example, an SIR goal of 0.50 correlates to a CAD of 15.

  • If the SIR goal is decreased to 0.25, the CAD becomes 22.5

  • Now let's talk about creating a TAP report.

  • Prior to running a TAP report, you should verify facilities are mapped to the appropriate

  • NHSN locations and that an up-to-date data set was generated.

  • Guidance on mapping NHSN locations can be found on the NHSN website.

  • TAP Reports are organized by facility type in the TAP Reports Folder in the analysis

  • reports section of NHSN.

  • The TAP Reports for all HAI types utilize 2015 baseline data, thus data analyzed are

  • from January 2015 to present.

  • Data from before January 2015, must be analyzed using the original baseline models.

  • These can be found in the Baseline Set One folder directly below the TAP Reports folder.

  • There are three options to select when running TAP Reports.

  • The first option isRun”, this option will run the default TAP Report.

  • The second option isModify”, this option allows the user to customize the default TAP Report.

  • The third option isExport Data Set”, selecting this option exports the data set for the report.

  • The default time period will provide a report inclusive of all data reported to NHSN that

  • are in the analysis datasets.

  • To limit the TAP Report by time period, the user must select a date range for the period

  • of interest by either year, half-year, quarter or month.

  • In general, at least one quarter period should be specified in order to have a representative

  • amount of data.

  • In this example, the data variable, “summaryYQis selected for summary data by quarter.

  • The Beginning and Ending fields are pre-formatted to help specify dates.

  • If we want to see data for quarters 1 through 3 of 2019; we enter this period in the provided fields.

  • For beginning date, enter 2019 then 1 to indicate the year and quarter in the empty field.

  • For ending date, we enter 2019 and 3.

  • Under the Display Options tab, users can select to use HHS goals, or a custom SIR goal.

  • HHS goals are the default goals for TAP Reports.

  • If a user does not change the Display options, the HHS goal for each specific HAI will automatically be used.

  • If a custom value is specified as the SIR Goal, this value must be less than 1.

  • Remember, the lower the SIR Goal the higher the prevention goal.

  • If a facility has reached the HHS target, they may want to set a more ambitious SIR goal.

  • The flexibility of this metric is important to keep in mind as you run, interpret, and

  • communicate information on the TAP reports.

  • As mentioned earlier each HAI type has a separate HHS 5-year HAI Reduction Target goal and these

  • are listed by HAI type on this slide.

  • Let's look at a sample TAP report.

  • In this example using the fictitious, DHQP Memorial Hospital, the user has submitted

  • data for many locations within the hospital.

  • All locations with data are ranked in descending order according to CAD.

  • The CAD promotes the use of data for action by helping the user quickly identify units

  • with excess HAIs.

  • Together with the SIR, the CAD can be used to identify and target prevention efforts

  • toward locations with higher CADs.

  • For the time period represented in the table, DHQP Memorial needed to prevent 26 CLABSIs

  • to meet the HHS goal for CLABSI of 0.05.

  • A closer look into our example reveals DHQP Memorial Hospital's 1 West location has

  • the highest CAD in the facility.

  • This location has a CAD of 13.08.

  • That's a majority of the facility's 26 CADs.

  • This hospital may opt to prioritize CLABSI prevention efforts within this location before

  • other locations in the hospital.

  • Targeting assessment resources and intervention methods to the unit with highest CAD is an

  • efficient way for this hospital to utilize HAI prevention resources.

  • Here are some helpful hints to keep in mind while running TAP reports.

  • Because TAP reports are built on the same guidelines that influence SIRs, the same rules

  • and exclusions will apply.

  • For example, hospital units that lack baseline data to calculate SIR values are excluded

  • from TAP reports.

  • Don't be alarmed if events on the hospital line listing cannot be found in the TAP report.

  • It may be an excluded location.

  • Remember to look at the footnotes.

  • The footnote provides information about the report including rules for interpreting data,

  • abbreviation meanings, pathogen names, and the date the report was generated.

  • Additionally, tables are easier to view in landscape if you choose a format other than

  • the default HTML.

  • On theTitle/Format Tab”, users can also choose to create the report using PDF, Microsoft

  • Excel, or Rich Text Format.

  • Above theTitle/FormatTab there is an option toShow descriptive variable names”.

  • This will create variable labels with more descriptive column headers.

  • Not only are they more descriptive, the variable labels also align with the descriptions found

  • in the footnotes.

  • There are many resources available for the TAP strategy.

  • Here are some of those links.

  • For more information about the Tap Strategy visit www.cdc.gov/nhsn.

  • And for help with TAP reports email nhsn@cdc.gov. Thank you.

Welcome to the 2019 National Healthcare Safety Network, or NHSN quick learn series.

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HAI予防への取り組み データを活用した予防のためのTAP(Targeted Assessment for Prevention)戦略 (Tapping into HAI Prevention Targeted Assessment for Prevention (TAP) Strategy Using Data for Action)

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    林宜悉 に公開 2021 年 01 月 14 日
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